Tissue Repair Devices

ABSTRACT

The present disclosure relates to an anchor assembly. The anchor assembly includes an anchor defining a cavity and an opening to the cavity and an insertion member configured for arrangement within the anchor cavity. Other anchor assemblies, anchors, and delivery devices are also disclosed.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.12/943,086 filed on Nov. 10, 2010, which claims priority to U.S. Pat.Appl. No. 61/259,737, filed Nov. 10, 2009, U.S. Pat. Appl. No.61/259,739, filed Nov. 10, 2009, U.S. Pat. Appl. No. 61/290,695, filedDec. 29, 2009, U.S. Pat. Appl. No. 61/312,481, filed Mar. 10, 2010, andU.S. Pat. Appl. No. 61/334,221, filed May 13, 2010, all of thedisclosures of which are incorporated herein by reference in theirentirety.

BACKGROUND

1. Field of Technology

The present disclosure relates to tissue repair devices, and morespecifically, to anchors, anchor assemblies, and delivery devices foruse in securing tissue to bone.

2. Related Art

Arthroscopic procedures often require soft tissue to be reattached tobone. To achieve this, anchors are placed in the bone and suturesattached to the anchor are passed through the tissue to securely retainthe tissue in place. A procedure and components for use in suchprocedure, that securely attaches tissue to bone, is needed. Suchprocedure must be able to be done in a quick and efficient manner with aminimum of recovery time for the patient.

SUMMARY

In an aspect, the present disclosure relates to an anchor assembly. Theanchor assembly includes an anchor defining a cavity and an opening tothe cavity; and a headless insertion member configured for arrangementwithin the anchor cavity, the insertion member including a body having athreaded proximal portion, a non-threaded distal portion, and acannulation extending a partial length of the insertion member. In anembodiment, the cannulation is triangular shaped. In another embodiment,the anchor cavity includes a threaded proximal portion and anon-threaded distal portion. In yet another embodiment, the distalportion of the insertion member includes two segments and a taperedportion located between the segments.

In another aspect, the present disclosure relates to an anchor assembly.The anchor assembly includes an anchor defining a cavity and an openingto the cavity and a headless insertion member configured for arrangementwithin the anchor cavity, the insertion member including a fullythreaded body and a cannulation extending a partial length of theinsertion member.

In yet another aspect, the present disclosure relates to a surgicaldevice. The surgical device includes a shaft including an outer memberand an inner member slidably received within the outer member, the outermember including an inner surface having threads and the inner memberincluding an outer surface having threads; a handle coupled to theshaft; and a knob coupled to the inner member, wherein the threads ofthe inner member and the threads of the outer member are engaged toallow for coupling of the inner member and the outer member and movementof the outer member relative to the inner member upon rotation of theknob. In an embodiment, the inner member is triangular-shaped. Inanother embodiment, the inner member includes a depth stop. In yetanother embodiment, the outer member includes a tip extending from anend of the outer member. In a further embodiment, the tip issquare-shaped.

In a further aspect, the present disclosure relates to an anchorassembly. The anchor assembly including an anchor defining a cavity andan opening to the cavity, the cavity including a non-threaded proximalportion and a threaded distal portion; and a headless insertion memberconfigured for arrangement within the anchor cavity, the insertionmember including a body and a cannulation extending a partial length ofthe insertion member, the body including a threaded proximal portion anda non-threaded distal portion. In an embodiment, the proximal portion issquare-shaped.

In yet a further aspect, the present disclosure relates to an anchor.The anchor includes a body defining a cavity and an opening to thecavity, the body including an outer surface and channels extending fromthe outer surface to the cavity. In an embodiment, the body includesbarbs, the channels located between the barbs. In another embodiment,the outer surface includes slots, the slots intersecting the barbs.

In an aspect, the present disclosure relates to an anchor assembly. Theanchor assembly including an anchor defining a cavity and an opening tothe cavity, the anchor including a body having an outer surface andbarbs extending from the body and alternating in direction along thelength of the body; and a headless insertion member configured forarrangement within the anchor cavity, the insertion member including abody and a cannulation extending a partial length of the insertionmember.

In another aspect, the present disclosure relates to an anchor assembly.The anchor assembly includes an anchor including an outer body and aninner body coupled to the outer body, the outer body including a firstfeature and a second feature, the inner body including a first featureand a second feature, the first feature of the inner body and the firstfeature of the outer body engaged to allow for non-rotation of the innerbody relative to the outer body and the second feature of the inner bodyand the second feature of the outer body engaged to allow fornon-movement of the inner body relative to the outer body in an axialdirection; and a headless insertion member configured for arrangementwithin the inner body, the insertion member including a body and acannulation extending a partial length of the insertion member.

In still another aspect, the present disclosure relates to an anchoringsystem that includes an anchor with a longitudinal axis extending alonga length of the anchor and a delivery device. The anchor may include ananchor body and an insertion member. The anchor body may include aproximal end positioned along the longitudinal axis, a distal endpositioned along the longitudinal axis and opposite from the proximalend, a cavity positioned along the longitudinal axis between theproximal end and the distal end, and an opening to the cavity at theproximal end of the anchor body, a transverse hole into the cavity,wherein the transverse hole includes a proximal edge and a distal edge,wherein there are ridges on an interior portion of the cavity atsubstantially the same longitudinal location as the transverse hole, andwherein the cavity extends distal of the distal edge of the transversehole and proximal of the proximal edge of the transverse hole. Theinsertion member may have an end with a substantially flat profile sizedand configured to be moved within the cavity such that the insertionmember, as measured from the substantially flat profile to another pointalong the insertion member, covers the transverse hole from a pointproximal of the proximal edge of the transverse hole to a point distalof the distal edge of the transverse hole. The delivery device may beconfigured to couple with the anchor and move the insertion memberrelative to the anchor body along the longitudinal axis.

In an aspect, the present disclosure relates to an anchoring system thatincludes an anchor with a longitudinal axis extending along a length ofthe anchor and a delivery device. The anchor may include an anchor bodyand an insertion member. The anchor body may include a proximal endpositioned along the longitudinal axis, a distal end positioned alongthe longitudinal axis and opposite from the proximal end, a cavitypositioned along the longitudinal axis between the proximal end and thedistal end, an opening to the cavity at the proximal end of the anchorbody, and a transverse hole into the cavity, wherein the transverse holeincludes a proximal edge and a distal edge, wherein there are ridges onan interior portion of the cavity at substantially the same longitudinallocation as the transverse hole, and wherein the cavity has a workingdiameter that extends distal of the distal edge of the transverse holeand proximal of the proximal edge of the transverse hole. Embodiments ofthe insertion member have a minimum diameter along a length of theinsertion member sized to substantially fill the working diameter of thecavity from a point proximal of the proximal edge of the transverse holeto a point distal of the distal edge of the transverse hole. Thedelivery device may be configured to couple with the anchor and move theinsertion member relative to the anchor body along the longitudinalaxis.

In another aspect, the present disclosure relates to an anchoring systemthat includes an anchor with a longitudinal axis extending along alength of the anchor and a delivery device. The anchor may include ananchor body and an insertion member. The anchor body may include aproximal end positioned along the longitudinal axis, a distal endpositioned along the longitudinal axis and opposite from the proximalend, a cavity positioned along the longitudinal axis between theproximal end and the distal end, an opening to the cavity at theproximal end of the anchor body, and a transverse hole into the cavity,wherein the transverse hole includes a proximal edge and a distal edge,wherein there are ridges on an interior portion of the cavity atsubstantially the same longitudinal location as the transverse hole, andwherein the cavity extends distal of the distal edge of the transversehole and proximal of the proximal edge of the transverse hole. Theinsertion member may be sized and configured to be moved within thecavity to cover the transverse hole, wherein the insertion memberincludes a typical outer body diameter, wherein the typical outer bodydiameter is smaller than a diameter of any threads on the insertionmember and smaller than a diameter of any head of the insertion memberand larger than a dimension of the transverse hole into the cavity thatis substantially perpendicular to the longitudinal axis of the anchor,and wherein the anchor is sized and configured such that the typicalbody diameter of the insertion member fits within the cavity from apoint proximal of the proximal edge of the transverse hole to a pointdistal of the distal edge of the transverse hole. The delivery devicemay be configured to couple with the anchor and move the insertionmember relative to the anchor body along the longitudinal axis.

Further areas of applicability of the present disclosure will becomeapparent from the detailed description provided hereinafter. It shouldbe understood that the detailed description and specific examples, whileindicating the preferred embodiment of the disclosure, are intended forpurposes of illustration only and are not intended to limit the scope ofthe disclosure.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and form a part ofthe specification, illustrate the embodiments of the present disclosureand together with the written description serve to explain theprinciples, characteristics, and features of the disclosure. In thedrawings:

FIG. 1 shows a side elevational view of a first embodiment of the anchorassembly of the present disclosure.

FIG. 2A shows a side elevational view of the anchor of the anchorassembly of FIG. 1.

FIG. 2B shows a cross-sectional view of the anchor of FIG. 2A.

FIG. 3A shows a side elevational view of the insertion member of theanchor assembly of FIG. 1.

FIG. 3B shows a cross-sectional view of the insertion member of FIG. 3A.

FIG. 4 shows an isometric view of the delivery device of the presentdisclosure.

FIG. 5 shows a cross-sectional view of the distal ends of the outer andinner members of the delivery device of FIG. 4 and the anchor assemblyof FIG. 1 prior to fixation of suture.

FIG. 6 shows a cross-sectional view of the distal ends of the outer andinner members of the delivery device of FIG. 4 and the anchor assemblyof FIG. 1 after fixation of suture.

FIG. 7 shows a cross-sectional view of the proximal ends of the outerand inner members of the delivery device of FIG. 4.

FIG. 8 shows a side elevational view of a second embodiment of theanchor assembly of the present disclosure.

FIG. 9 shows a side elevational view of the anchor of the anchorassembly of FIG. 8.

FIG. 10 shows a cross-sectional view of the anchor of FIG. 9.

FIG. 11 shows a side elevational view of the insertion member of theanchor assembly FIG. 8.

FIG. 12 shows a cross-sectional view of the insertion member of FIG. 11.

FIG. 13 shows an isometric view of the delivery device for use with theanchor assembly of FIG. 8.

FIG. 14 shows a cross-sectional view of the delivery device and anchorassembly of FIG. 13 prior to use of the device and assembly duringsurgery.

FIG. 14A shows an exploded view of the distal end of the delivery deviceand the anchor assembly of FIG. 14.

FIG. 14B shows an exploded view of the proximal ends of the outer andinner members of the delivery device of FIG. 14.

FIG. 15 shows a cross-sectional view of the delivery device and anchorassembly of FIG. 13 after use of the device and assembly during surgery.

FIG. 15A shows an exploded view of the distal end of the delivery deviceand the anchor assembly of FIG. 15.

FIG. 15B shows an exploded view of the proximal ends of the outer andinner members of the delivery device of FIG. 14.

FIGS. 16-27 show a method of tissue repair via use of the deliverydevice and anchor assembly of FIGS. 1 and 13.

FIG. 28 shows a side elevational view of a third embodiment of theanchor assembly of the present disclosure.

FIG. 29 shows a side elevational view of the anchor of the anchorassembly of FIG. 28.

FIG. 30 shows a side view of the anchor of FIG. 29.

FIG. 31 shows a cross-sectional view of the anchor of FIG. 29.

FIG. 32 shows a side elevational view of the insertion member of theanchor assembly of FIG. 28.

FIG. 33 shows a cross-sectional view of the insertion member of FIG. 32.

FIG. 34 shows an isometric view of the delivery device for use with theanchor assembly of FIG. 28.

FIG. 34A shows an exploded view of the distal end of the delivery deviceof FIG. 34.

FIG. 35 shows an isometric view of the delivery device and anchorassembly of FIGS. 28 and 34.

FIG. 36 shows a cross-sectional view of the delivery device and anchorassembly of FIG. 35 prior to use of the device and assembly duringsurgery.

FIG. 36A shows an exploded view of the proximal ends of the outer andinner members of the delivery device of FIG. 36.

FIG. 36B shows an exploded view of the anchor assembly of FIG. 36

FIG. 37 shows a cross-sectional view of the delivery device and anchorassembly of FIG. 35 after to use of the device and assembly duringsurgery.

FIG. 37A shows an exploded view of the proximal ends of the outer andinner members of the delivery device of FIG. 37.

FIG. 37B shows an exploded view of the anchor assembly of FIG. 37.

FIG. 38 shows an isometric view of a first embodiment of a fenestratedsuture anchor of the present disclosure.

FIG. 39 shows a side view of the anchor of FIG. 38.

FIG. 40 shows a cross-sectional view of the anchor of FIG. 39.

FIG. 41 shows a side elevational view of a second embodiment of afenestrated suture anchor of the present disclosure.

FIG. 42 shows a cross sectional view of the anchor of FIG. 41.

FIG. 43 shows a side elevational view of a third embodiment of afenestrated suture anchor of the present disclosure.

FIG. 44 shows a cross-sectional view of the anchor of FIG. 43.

FIG. 45 shows a side view of a fourth embodiment of the anchor assemblyof the present disclosure.

FIG. 46 shows a side elevational view of the anchor assembly of FIG. 45.

FIG. 47 shows a side view of a fifth embodiment of the anchor assemblyof the present disclosure.

FIG. 48 shows a side elevational view of the anchor assembly of FIG. 47.

FIG. 49 shows a side view of a sixth embodiment of the anchor assemblyof the present disclosure.

FIG. 50 shows a side elevational view of the anchor assembly of FIG. 49.

FIG. 51 shows a side view of a seventh embodiment of the anchor assemblyof the present disclosure.

FIG. 52 shows a cross-sectional view of the anchor assembly of FIG. 51.

FIG. 53 shows a side view of an eighth embodiment of the anchor assemblyof the present disclosure.

FIG. 54 shows a cross-sectional view of the anchor assembly of FIG. 53.

DETAILED DESCRIPTION OF THE EMBODIMENTS

The following description of the preferred embodiment(s) is merelyexemplary in nature and is in no way intended to limit the disclosure,its application, or uses.

FIGS. 1, 2A-2B, and 3A-3B show a first embodiment of the anchor assembly10 of the present disclosure and its components. The assembly 10includes the anchor 20 and the insertion member 30. The anchor 20includes a proximal portion 21, a distal portion 22, and an inner cavity23. An opening 24 to the cavity 23 is located at the proximal portion 21of the anchor 20. The anchor 20 also includes a transverse hole 25extending through the anchor 20. The through hole 25 is for housing of aflexible member, such as suture. Openings 25 a, 25 b are located at eachend of the through hole 25. The outer surface 27 of the proximal portion21 also includes barbs 28 for substantially reducing the possibility ofremoval of the anchor 20 when inserted into bone. The outer surface 27also includes at least two slots 29 extending from the openings 25 a, 25b of the through hole 25. The slots 29 intersect the barbs 28 and areconfigured for housing of the suture after positioning of the anchor 20in bone. As shown in FIG. 2B, the cavity 23 extends into and beyond thethrough hole 25 and includes a threaded proximal portion 23 a and anon-threaded distal portion 23 b. Also shown in FIG. 2B are a pair ofdepressions 26, each of which is located adjacent to the cavity 23. Thedepressions 26 are for housing of a delivery device, as will be furtherexplained later.

The insertion member 30 includes a headless body 31 having a threadedproximal portion 31 a and a non-threaded distal portion 31 b. The distalportion 31 b includes two segments 31 b′, 31 b″ and a tapered portion 31c located between the segments 31 b′, 31 b″. Segment 31 b″ has a flatend portion 31 d. As shown in FIGS. 3A and 3B, the member 30 includes atriangular-shaped cannulation 31 e that extends a partial length of themember 30. The threads 31 a′ are configured for engagement with thethreads 23 c of the cavity 23 when the insertion member 30 is arrangedwithin the cavity 23, as will be further explained below.

FIGS. 4-7 show the delivery device 40 of the present disclosure. Thedevice 40 includes a shaft 41, a handle 42 coupled to the shaft 41, anda knob 43 coupled to the handle 42. The shaft 41 includes an outermember 41 a and an inner member 41 b slidably disposed within andcoupled to the outer member 41 a. The inner member 41 b includes adistal end 41 b′ configured for disposal within the cannulation 31 e ofthe insertion member 30 and a proximal end 41 b″ coupled to the knob 43.The end 41 b′ is of a diameter such that it engages the wall 31 e′ ofthe cannulation 31 e, thereby allowing movement of the member 30 whenthe knob 43 is rotated, as will be further described below. The outermember 41 a includes prongs 41 c located at a distal end 41 a′ of theouter member 41 a and a proximal end 41 a″ coupled to the handle 42.

Prior to use, suture 44 is disposed within the through hole 25 and ends44 a, 44 b of the suture 44 are fixed to suture holders 45 located onhandle 42. The suture 44 helps to keep anchor 20 coupled to the shaft41. The delivery device 40 and its components, especially the handle 42and knob 43, is similar to the delivery device shown and described in USPatent Application Publication 20100016869, the disclosure of which isincorporated herein by reference in its entirety. The ends 44 a, 44 b ofthe suture 44 are also housed within channels 46 that extend along theshaft 41. A suture threader 11000 is also releasably coupled to theshaft 41. Threader 11000 includes a clip 11000 a and a loop of suture11000 b coupled to the clip 11000 a. Suture loop 11000 b is disposedwithin the through hole 25 and placed around the clip 11000 a.

As shown in FIG. 5, the prongs 41 e are disposed within the depressions26. Once the anchor assembly 10 is disposed within bone, the prongs 41 chelp to hold the anchor 20 stationary while the insertion member 30 ismoved relative to the anchor 20 via rotation of the knob 43. As will befurther described below, FIG. 5 shows the location of the insertionmember 30 prior to fixation of suture within the cavity 23, while FIG. 6shows the location of the insertion member 30 after fixation of suturewithin the cavity 23. The non-threaded distal portion 31 b is configuredto be housed within the non-threaded distal portion 23 b of the anchor20.

Additionally, as shown in FIG. 7, the proximal end 41 b″ of the innermember 41 b includes threads 41 d on an outer surface 41 e of the innermember 41 b and the proximal end 41 a″ of the outer member 41 a includesthreads 411 f on an inner surface 41 g of the outer member 41 a. Threads411 f engage threads 41 d to allow for coupling of the outer and innermembers 41 a, 41 b and axial movement of the inner member 41 b relativeto the outer member 41 a, via rotation of the knob 43. Axial movement ofthe inner member 41 b relative to the outer member 41 a allows for axialmovement of the insertion member 30 to the two locations shown in FIGS.5 and 6.

FIGS. 8-12 show a second embodiment of the anchor assembly 100 of thepresent disclosure and its components. The assembly 100 includes theanchor 200 and the insertion member 300. The anchor 200 includes aproximal portion 210, a distal portion 220, and an inner cavity 230. Anopening 240 to the cavity 230 is located at the proximal portion 210 ofthe anchor 200. The anchor 200 also includes a transverse hole 250extending through the anchor 200. The through hole 250 is for housing ofa flexible member, such as suture. Openings 250 a, 250 b are located ateach end of the through hole 250. The outer surface 270 of the proximalportion 210 also includes barbs 280 for substantially reducing thepossibility of removal of the anchor 200 when inserted into bone. Theouter surface 270 also includes at least two slots 290 extending fromthe openings 250 a, 250 b of the through hole 250. The slots 290intersect the barbs 280 and are configured for housing of the sutureafter positioning of the anchor 200 in bone. As shown in FIG. 10, thecavity 230 extends into and beyond the through hole 250. Also shown inFIG. 10 are a pair of depressions 260, each of which is located adjacentto the cavity 230. The depressions 260 are for housing of a deliverydevice, as will be further explained later.

The insertion member 300 includes a body 310 having threads 310 a, adistal portion 310 b, and a proximal portion 310 c. As shown in FIGS. 8,11, and 12, the member 300 includes a triangular-shaped cannulation 310d that extends a partial length of the member 300. The threads 310 a areconfigured for engagement with the threads 230 c of the cavity 230 whenthe insertion member 300 is arranged within the cavity 230, as will befurther explained below.

FIGS. 13-14, 14A-14B, 15, and 15A-15B show the delivery device 400 ofthe present disclosure for use with the anchor assembly 100 of FIG. 8.The device 400 includes a shaft 410, a handle 420 coupled to the shaft410, and a knob 430 coupled to the handle 420. The shaft 410 includes anouter member 410 a and an inner member 410 b slidably disposed withinand coupled to the outer member 410 a. The inner member 410 b includes adistal end 410 b′ configured for disposal within the cannulation 310 dof the insertion member 300 and a proximal end 410 b″ coupled to theknob 430. The end 410 b′ is of a diameter such that it engages the wall310 d′ of the cannulation 310 d, thereby allowing movement of the member30 when the knob 430 is rotated, as will be further described below. Theouter member 410 a includes prongs 410 c located at a distal end 410 a′of the outer member 410 a and a proximal end 410 a″ coupled to thehandle 420.

Prior to use, suture 440 is disposed within the through hole 250 andends 440 a, 440 b of the suture 440 are fixed to suture holders 450located on handle 420. The suture 440 helps to keep anchor 200 coupledto the shaft 410. The delivery device 400 and its components, especiallythe knob 430, is similar to the delivery device shown and described inthe '869 publication. The ends 440 a, 440 b of the suture 440 are alsohoused within channels 460 that extend along the shaft 410. A suturethreader 12000 is also releasably coupled to the shaft 410. Threader12000 includes a clip 12000 a and a loop of suture 12000 b coupled tothe clip 12000 a. Suture loop 12000 b is disposed within the throughhole 250 and placed around the clip 12000 a.

As shown in FIGS. 14A and 15A, the prongs 410 c are disposed within thedepressions 260. Once the anchor assembly 100 is disposed within bone,the prongs 410 c help to hold the anchor 200 stationary while theinsertion member 300 is moved relative to the anchor 200 via rotation ofthe knob 430. As will be further described below, FIG. 14A shows thelocation of the insertion member 300 prior to fixation of suture withinthe through hole 250, while FIG. 15A shows the location of the insertionmember 300 after fixation of suture within the through hole 250.

Additionally, as shown in FIGS. 14B and 15B, the proximal end 410 b″ ofthe inner member 410 b includes threads 410 d on an outer surface 410 eof the inner member 410 b and the proximal end 410 a″ of the outermember 410 a includes threads 410 f on an inner surface 410 g of theouter member 410 a. Threads 410 f engage threads 410 d to allow forcoupling of the outer and inner members 410 a, 410 b and axial movementof the inner member 410 b relative to the outer member 410 a. Axialmovement of the inner member 410 b relative to the outer member 410 aallows for axial movement of the insertion member 300 to the twolocations shown in FIGS. 14A and 15A. Member 410 b also includes a depthstop 410 b′″ that engages an end 410 a′″ of member 410 a, as shown inFIG. 15B, once member 300 is located as shown in FIG. 15A. Interactionof the depth stop 410 b′″ with the end 410 a′″ ceases axial movement ofthe member 300 toward the through hole 250 and prevents the member 300from being overly inserted into the cavity 230. The insertion member 300is moved axially towards the through hole 250 to engage the flexiblemember and secure the flexible member within the cavity 230, which willbe further described below.

FIGS. 16-27 show the anchor assembly 10, 100 of the present disclosurein use during soft tissue repair, specifically to repair labrum tears inthe shoulder. As shown in FIG. 16, the labrum 2000 has been torn awayfrom the glenoid cavity 3000 and is in need of being re-attached. FIG.16 shows a monofilament suture loop 4001 from a suture passer 4000 beinginserted through the labrum 2000 via use of a first cannula 5000. Agrasper 6000 from a second cannula 7000 grabs the loop 4001 and pulls itthrough the second cannula 7000. Once the loop 4001 is pulled throughthe second cannula 7000, one end 8001 of a suture 8000 is passed throughthe loop 4001. The one end 8001 of the suture 8000 is pulled through thelabrum 2000 and first cannula 5000 via the loop 4001, while the otherend 8002 is grasped and pulled through the first cannula 5000 to haveboth ends 8001, 8002 exiting the cannula 5000, as shown in FIG. 17.

A hole 3001 is then made in the glenoid 3000 via the use of a drillguide 9000 and drill 10000, as shown in FIGS. 18 and 19. The ends 8001,8002 are placed through the suture threader loop 11000 b, 12000 b andpulled through the through hole 25,250 of the anchor 20, 200, as shownin FIGS. 20 and 21. The suture 44,440 is removed from the deliverydevice 40,400 prior to inserting the anchor assembly 10, 100 into thehole 3001. After the anchor assembly 10, 100 is inserted into the hole3001, as shown in FIGS. 22 and 23, the suture ends 8001, 8002 aretensioned and the ends 8001, 8002 are locked by placing the ends 8001,8002 in the suture holder 45, 450, as shown in FIG. 24, and the innerplug 30, 300 is then rotated, via rotation of the knob 43, 430 to fixatethe suture 8000 in the cavity 23, 230.

The suture ends 8001, 8002 are cut, as shown in FIG. 26, and thedelivery device 40, 400 is removed. Additional anchor assemblies 10, 100may be inserted until the desired final repair is completed, as shown inFIG. 27. For clarity purposes, only end 8001, suture loop 12000 b, andanchor assembly 100 are shown in FIGS. 20-23. However, in practice, bothends 8001, 8002 are used and suture loop 11000 b and anchor assembly 10may be used rather than suture loop 12000 b and anchor assembly 100.

FIGS. 28-33 show an alternative embodiment of the anchor assembly 500 ofthe present disclosure and its components. The assembly 500 includes theanchor 600 and the insertion member 700. The anchor 600 includes aproximal portion 610, a distal portion 620, and an inner cavity 630. Theinner cavity 630 will be further described below. An opening 640 to thecavity 630 is located at the proximal portion 610 of the anchor 600. Theanchor 600 also includes a transverse hole 650 extending through theanchor 600. The through hole 650 is for housing of a flexible member,such as suture. Openings 650 a, 650 b are located at each end of thethrough hole 650. The outer surface 670 of the proximal portion 610 alsoincludes wings 680 for substantially reducing the possibility of removalof the anchor 600 when inserted into bone. The wings 680 are unlikebarbs 28, 280 in that wings 680 are longer, have more space betweenthem, and extend further upward and outward then barbs 28, 280. Theouter surface 670 also includes at least two slots 690 extending fromthe openings 650 a, 650 b of the through hole 650. The slots 690intersect the wings 680 and are configured for housing of the sutureafter positioning of the anchor 600 in bone. As shown in FIG. 10, thecavity 630 extends into and beyond the through hole 650 and includes anon-threaded proximal portion 630 a and a threaded distal portion 630 b.The proximal portion 630 a is square-shaped to correspond with an end ofthe delivery device used to insert the anchor 600 into bone, as will befurther described below. The proximal portion 630 a also has a largerdiameter and is shorter than the distal portion 630 b.

The insertion member 700 includes a body 710 having a threaded proximalportion 710 a and a non-threaded distal portion 710 b. The proximalportion 710 a has a larger diameter than the distal portion 710 b. Themember 700 includes a triangular-shaped cannulation 710 e that extends apartial length of the member 700. The threads 710 a′ are configured forengagement with the threads 630 c of the cavity 630 when the insertionmember 700 is arranged within the cavity 630, as will be furtherexplained below.

FIGS. 34, 34A, 35, 35, 36, 36A-36B, and 37A-37B show the delivery device800 of the present disclosure. The device 800 includes a shaft 810, ahandle 820 coupled to the shaft 810, and a knob 830 coupled to thehandle 820. The shaft 810 includes an outer member 810 a and an innermember 810 b slidably disposed within and coupled to the outer member810 a. The inner member 810 b includes a distal end 810 b′ configuredfor disposal within the cannulation 710 e of the insertion member 700and a proximal end 810 b″ coupled to the knob 830. The end 810 b′ is ofa diameter such that it engages the wall 710 e′ of the cannulation 710e, thereby allowing movement of the member 700 when the knob 830 isrotated, as will be further described below. The outer member 810 aincludes a square-shaped tip 810 c extending from a distal end 810 a′ ofthe outer member 810 a and a proximal end 810 a″ coupled to the handle820.

The handle 820 includes suture holders 850, each suture holder 850extending from a side of the handle 820. Additionally, as shown in FIG.34, a flexible member 900, such as a suture, is housed within thethrough hole 650 with each end 900 a, 900 b of the member 900 beingcoupled to a holder 850. The flexible member 850 helps to hold theanchor 600 on the device 800 prior to insertion of the anchor 600 intobone. The ends 900 a, 900 b of the suture 900 are also housed withinchannels 860 that extend along the shaft 810. A suture threader 13000 isalso releasably coupled to the shaft 81. Threader 13000 includes a clip13000 a and a loop of suture 13000 b coupled to the clip 13000 a. Sutureloop 13000 b is disposed within the through hole 650 and placed aroundthe clip 13000 a. The delivery device 800 and its components, especiallythe knob 830, are similar to the delivery device shown and described inthe '869 publication.

As shown in FIGS. 36 and 37, the tip 810 c is disposed within theproximal portion 630 a. Once the anchor assembly 500 is disposed withinbone, the tip 810 c helps to hold the anchor 600 stationary while theinsertion member 700 is moved relative to the anchor 600. Additionally,as shown in FIG. 14A, the proximal end 810 b″ of the inner member 810 bincludes threads 810 d on an outer surface 810 e of the inner member 810b and the proximal end 810 a″ of the outer member 810 a includes threads810 f on an inner surface 810 g of the outer member 810 a. Threads 810 fengage threads 810 d to allow for coupling of the outer and innermembers 810 a, 810 b and axial movement of the inner member 810 brelative to the outer member 810 a.

Axial movement of the inner member 810 b relative to the outer member810 a allows for axial movement of the insertion member 700 to the twolocations shown in FIGS. 36B and 37B. Member 810 b also includes a depthstop 810 b′″ that engages an end 810 a′″ of member 810 a, as shown inFIG. 37A, once member 700 is located as shown in FIG. 37B. Interactionof the depth stop 810 b′″ with the end 810 a′″ ceases axial movement ofthe member 700 toward the through hole 650 and prevents the member 700from being overly inserted into the cavity 630. The insertion member 700is moved axially towards the through hole 650 to engage the flexiblemember and secure the flexible member within the cavity 630, which willbe further described below.

During tissue repair via use of the anchor assembly 500 and the driver800, suture from a previously placed anchor is pulled through thethrough hole 650. The manner in which the suture is pulled through thethrough hole 650 may be the same as the manner described in the '106 and'180 patent applications. The anchor assembly 500 is subsequentlyinserted into bone, via use of the driver 800, in the manner shown inFIG. 36B. Axial advancement of the anchor assembly 500 into the bone mayoccur via tapping on the handle 820. After the soft tissue is situatedon the bone and the suture is located through the soft tissue, in themanner described in the '106 and '180 patent applications, the insertionmember 700 is moved axially towards the distal portion 630 b, viarotation of the knob 830 to engage the suture and secure the suturewithin the cavity 630, in the manner shown in FIG. 37B. For claritypurposes, only the anchor assembly 500 is shown in FIGS. 36B and 37B.However, a further description and showing of a method of tissue repairsimilar to the above-described method, is shown in the '106 and '180published applications.

The components of the anchor assemblies 10, 100, 500 are made from abioabsorbable polymer material via an injection molding process.However, other materials and processes may be used. In addition, thesuture material is made from a bioabsorbable polymer material, but othermaterial may be used. Furthermore, the outer surface 27, 270, 670 of theanchors 20, 200, 600 may include features other than barbs and wings 28,280, 680 to reduce the possibility of removal of the anchor 20, 200, 600and the barbs 28, 280, 680 may extend the entire length or a partiallength of the anchor 20, 200, 600. Similarly, the body 31, 310, 710 ofthe insertion member 30, 300, 700 and the cavity 23, 230, 630 of theanchor 20, 200, 600 may include features other than threads tofacilitate insertion and removal of the insertion member 30, 300, 700and the threads 31 a′, 310 a, 710 a′ may extend the entire length or apartial length of the body 31, 310, 710 and cavity 23, 230, 630. Also,for the purposes of this disclosure, the through hole 25, 250, 650 maybe located anywhere along the length of the anchor 20, 200, 600.Additionally, it is within the scope of this disclosure for the anchor20, 200, 600 to have more or less than two slots 29, 290, 690.

Additionally, for the purposes of this disclosure, the outer member 41a, 410 a includes at least one prong 41 c, 410 c and the anchor 20, 200includes at least one corresponding depression 26, 260. Also, thecannulation 31 e, 310 e of the insertion member 30, 300 may extend anentire length of the insertion member 30,300 and may include a shapeother than triangular.

The outer and inner members 41 a, 41 b, 410 a, 410 b, 810 a, 810 b ofthe delivery device 40, 400, 800 include a stainless steel material, butmay be made from any other metal or non-metal material that isbio-compatible and strong enough to withstand the forces that are placedon the members 41 a, 41 b, 410 a, 410 b, 810 a, 810 b during surgery.The members 41 a, 41 b, 410 a, 410 b, 810 a, 810 b may be machined, diedrawn and subsequently machined, or made by any other method known toone of skill in the art. The outer and inner members 41 a, 41 b, 410 a,410 b, 810 a, 810 b are coupled to the handle 42, 420, 820 and knob 43,430, 830 respectively, via a press-fit procedure. However, other methodsof coupling the handle 42, 420, 820 and knob 43, 430, 830 to the members41 a, 41 b, 410 a, 410 b, 810 a, 810 b are also within the scope of thisdisclosure. The handle 42, 420, 820 and knob 43, 430, 830 are of anon-metal material, but may be made from a metal material, and both aremade via an injection molding process. However, other methods of makingare also within the scope of this disclosure.

FIGS. 38-40 show a first embodiment of a fenestrated suture anchor 1000of the present disclosure. The anchor 1000 includes a body 1001 having aproximal portion 1001 a and a distal portion 1001 b, a transversethrough hole 1002 located between the distal and proximal portions 1001b, 1001 a, and a cavity 1003 extending a partial length of the body1001. Wings 1004 exist along the body 1001 and outward from it. Similarto the wings 680, wings 1004 engage bone when the anchor 1000 isinserted into the bone, as will be further described below. The body1001 also includes suture slots 1005 extending from openings 1002 a,1002 b of the hole 1002. Additionally, there are channels 1006 extendingalong the body 1001 on both sides of the slots 1005. The channels 1006extending from an outer surface 1007 of the anchor 1000 to the cavity1003, thereby allowing the anchor 1000 to be fenestrated. The channels1006 allow for ingrowth of tissue, such as bone, and other nutrientsafter insertion of the anchor 1000 into bone, as will be furtherdescribed later. A suture 1008 is housed within the hole 1002 having itsends 1008 a, 1008 b housed within the slots 1005.

FIGS. 41-42 show a second embodiment of a fenestrated suture anchor1100. The anchor 1100 includes a body 1101 having a proximal portion1101 a and a distal portion 1101 b, a transverse through hole 1102located between the distal and proximal portions 1101 b, 1101 a, and acavity 1103 extending a partial length of the body 1101. Barbs 1104exist along the body 1101 and extend outward from it. Similar to thebarbs 28, 280, barbs 1104 engage bone when the anchor 1100 is insertedinto the bone, as will be further described below. The body 1101 alsoincludes channels 1106 extending along the body 1101. The channels 1106extending from an outer surface 1107 of the anchor 1100 to the cavity1103, thereby allowing the anchor 1100 to be fenestrated. The channels1106 allow for ingrowth of tissue, such as bone, and other nutrientsafter insertion of the anchor 1100 into bone, as will be furtherdescribed later. A suture 1108 is housed within the hole 1102 having itsends 1108 a, 1108 b extend through openings 1102 a, 1102 b and then backthrough the cavity 1103, as shown in FIG. 41.

FIGS. 43-44 show a first embodiment of a fenestrated suture anchor 1200of the present disclosure. The anchor 1200 includes a body 1201 having aproximal portion 1201 a and a distal portion 1201 b, a transversethrough hole 1202 located between the distal and proximal portions 1201b, 1201 a, and a cavity 1203 extending a partial length of the body1201. Barbs 1204 exist along the body 1201 and extend outward from it.Similar to the barbs 28, 280, barbs 1204 engage bone when the anchor1200 is inserted into the bone, as will be further described below. Thebody 1201 also includes suture slots 1205 extending from openings 1202a, 1202 b of the hole 1202. Additionally, there are channels 1206extending along the body 1201 interspaced with the slots 1205. Thechannels 1206 extend from an outer surface 1207 of the anchor 1200 tothe cavity 1203, thereby allowing the anchor 1200 to be fenestrated. Thechannels 1206 allow for ingrowth of tissue, such as bone, and othernutrients after insertion of the anchor 1200 into bone, as will befurther described later. A suture 1208 is housed within the hole 1202having its ends 1208 a, 1208 b housed within the slots 1205.

During repair of tissue via use of the suture anchors 1000, 1100, 1200,a delivery device having a handle and a shaft may be used to deliver theanchors into bone. An end of the shaft may be inserted into the cavityof the anchors and may have the same shape as cavity. The anchors 1000,1100, 1200 are designed to be inserted into bone via axial motion. Thetorn tissue may then be placed on the bone, adjacent the anchors 1000,1100, 1200. Subsequently, the suture may then be pulled through thetissue and tied to attach the tissue to the bone. A hole may be drilledin the bone prior to inserting the anchors 1000, 1100, 1200 into thebone.

FIGS. 45-50 show anchor assemblies 1300, 1400, 1500 similar to theanchor assemblies 10 of FIGS. 1, 8, and 28. The anchor assemblies 1300,1400, 1500 are similar to the anchor assemblies 10, 100, 500 of FIGS. 1,8, and 28 and the anchor assemblies shown and described in US PatentApplication Publication No. 20090112270, the disclosure of which isincorporated herein by reference in its entirety, and the '869publication mentioned above. FIGS. 45-50 only show the anchors 1310,1410, 1510 of the assemblies 1300, 1400, 1500. Although for the purposesof this disclosure, an insertion member, similar to the insertionmembers shown in the above mentioned figures and publications, wouldalso be used with the anchors 1310, 1410, 1510. However, it is possiblethat the anchors 1310, 1410, 1510 could be used without insertionmembers, thereby being used in a similar manner to anchors 1000, 1100,1200 during surgery.

FIGS. 45-46 show an anchor 1310 having barbs 1320 that extend outwardfrom the body 1330 of the anchor 1310 and along its entire length onboth sides. The barbs 1320 alternate in direction along the length ofthe anchor 1310. Similar to wings 680, extending the barbs 1320 outwardfrom the body 1330 increases the overall surface area of the barbs 1320and allows flexibility, which improves resistance to anchor pull-out,thereby reducing the possibility of removal of the anchor 1300 wheninserted into bone. FIGS. 47-50 show anchors 1410, 1510, which includebarbs 1420, 1520, similar in design and orientation, to barbs 1320 ofanchor 1310. Unlike anchor 1310, the barbs 1420, 1520 do not extendalong the entire length of the anchor 1410, 1510 and the distal end1440, 1540 of the anchor 1410, 1510 is pointed thereby making itpossible to insert the anchor 1410, 1510 into bone without firstcreating a hole in the bone.

FIGS. 51 and 52 show an anchor 1610 that includes an outer body 1620 andan inner body 1630 disposed within the outer body 1620. The outer body1620 includes an outer surface 1621 having wings 1622, similar to wings680, and an inner cavity 1623. The distal end 1624 of the inner cavity1623 includes a first feature 1625 and a second feature 1626, which willbe more fully explained below in relation to the inner body 1630.Similar to the anchors described above, the outer body 1620 alsoincludes a transverse hole 1627 and slots 1628. Similar to the anchorsdescribed above, the inner body 1630 includes a threaded inner cavity1631, a through hole 1632, a proximal portion 1633, and a distal portion1634. The inner body 1630 includes a first feature 1635 and a secondfeature 1636, both of which are located between the proximal and distalportions 1633, 1634 and which will be more fully explained below inrelation to the outer body 1620. The inner body 1630 is disposed withinthe outer body 1620 such that the outer body first feature 1625 islocated within the inner body first feature 1635 and the outer bodysecond feature 1626 is located within the inner body second feature1636. The first features 1625, 1635 are shaped so as to substantiallyreduce the possibility of the inner body 1630 rotating in relation tothe outer body 1620 during repair, as will be more fully describedbelow. The second features 1626, 1636 are shaped so as to substantiallyreduce the possibility of the inner body 1630 from moving axially inrelation to the outer body 1620 during insertion of the anchor 1610 intobone, as will be more fully described below. Additionally, the throughholes 1627, 1632 are aligned.

Similar to anchors 1310, 1410, 1510, anchor 1610 is part of an anchorassembly. However, for clarity purposes, the anchor 1610 is shownwithout an inner member. The distal portion 1634 of the inner body 1630is pointed and the proximal portion 1633 does not extend the entirelength of the inner cavity 1623, the purposes of which will be describedlater.

During insertion of the anchor 1610 into bone, a delivery device 1700,similar to delivery device 800, is used. For clarity purposes, only theouter member 1710 a of the shaft 1710 is shown in FIGS. 51 and 52. Theouter member 1710 a is inserted into the anchor 1610 such that thesquare-shaped tip 1710 c is inserted into the inner cavity 1623. The tip1710 c engages the inner body 1630 such that there is a clearance 1800between the distal end 1710 a′ of the shaft 1710 and the anchor 1610.During insertion of the anchor 1610 into bone, the outer member 1710 aonly engages the inner body 1630, thereby asserting all of the axialforce of the outer member 1710 a on the inner body 1630, rather than theouter body 1620. The cooperation of the second features 1626, 1636substantially reduces the possibility of the inner body 1630 becomingunlocked from the outer body 1620 during axial insertion of the anchor1610 into the bone. After insertion of the anchor 1610 into bone, athreaded inner member is rotationally inserted into the cavity 1631 viathe use an inner member on the delivery device 1700, similar to themethod of repair described above. During rotational insertion of theinner member into the cavity 1631, the cooperation of the first features1625, 1635 substantially reduces the possibility of rotation of theinner body 1630 in relation to the outer body 1620. The pointed distalportion 1634 of the inner body 1630 allows for insertion of the anchor1610 into bone without having to create a hole in the bone prior toinsertion.

For the purposes of this disclosure, the inner body 1630 is made from ametal material and the outer body 1620 is made from a polymer material.The outer and inner bodies 1620, 1630 are coupled to each other via aninterference fit or overmolding. However, other materials and manners ofcoupling may be used.

FIGS. 53 and 54 show an anchor 1900 similar to the anchor 600, albeitwith a distal portion 1920 that is pointed enough to allow for insertionof the anchor 1900 into bone without first creating a hole in bone.

As various modifications could be made to the exemplary embodiments, asdescribed above with reference to the corresponding illustrations,without departing from the scope of the disclosure, it is intended thatall matter contained in the foregoing description and shown in theaccompanying drawings shall be interpreted as illustrative rather thanlimiting. Thus, the breadth and scope of the present disclosure shouldnot be limited by any of the above-described exemplary embodiments, butshould be defined only in accordance with the following claims appendedhereto and their equivalents.

What is claimed is:
 1. An anchoring system comprising: an anchor with alongitudinal axis extending along a length of the anchor, the anchorcomprising: an anchor body comprising: a proximal end positioned alongthe longitudinal axis, a distal end positioned along the longitudinalaxis and opposite from the proximal end, a cavity positioned along thelongitudinal axis between the proximal end and the distal end, anopening to the cavity at the proximal end of the anchor body, and atransverse hole into the cavity, wherein the transverse hole includes aproximal edge and a distal edge, wherein there are ridges on an interiorportion of the cavity at substantially the same longitudinal location asthe transverse hole, and wherein the cavity extends distal of the distaledge of the transverse hole and proximal of the proximal edge of thetransverse hole, and an insertion member with an end having asubstantially flat profile sized and configured to be moved within thecavity such that the insertion member, as measured from thesubstantially flat profile to another point along the insertion member,covers the transverse hole from a point proximal of the proximal edge ofthe transverse hole to a point distal of the distal edge of thetransverse hole; and a delivery device configured to couple with theanchor and move the insertion member relative to the anchor body alongthe longitudinal axis.
 2. The anchoring system of claim 1 wherein thetransverse hole into the cavity goes through each side of the anchorbody and goes through the cavity between each side of the anchor body.3. The anchoring system of claim 1 wherein the ridges are formed bythreads within the cavity.
 4. The anchoring system of claim 1 whereinthe anchor body includes one or more barbs on an exterior of the anchorbody positioned to resist proximal movement of the anchor from a bone.5. The anchoring system of claim 1 wherein the anchor body includes oneor more protrusions on an exterior of the anchor body located distal ofthe transverse hole into the cavity.
 6. The anchoring system of claim 1wherein the anchor body includes a pointed distal portion configured forinsertion into a bone without prior creation of a hole in the bone. 7.The anchoring system of claim 1 wherein the insertion member is headlesssuch that the insertion member is configured to be driven by placing aninner member of the delivery device into a proximal end of the insertionmember without engaging any head of the insertion member.
 8. Theanchoring system of claim 1 wherein the end of the insertion memberhaving a substantially flat profile is a substantially solidsubstantially flat end.
 9. The anchoring system of claim 1 wherein theend having a substantially flat profile is a distal end of the insertionmember.
 10. The anchoring system of claim 1 wherein the insertion memberis sized and configured to be moved distally and proximally within thecavity of the anchor body.
 11. The anchoring system of claim 1 whereinthe substantially flat profile may be located at a point distal of thedistal edge when the insertion member covers the transverse hole from apoint proximal of the proximal edge to a point distal of the distaledge.
 12. The anchoring system of claim 1 wherein the delivery deviceincludes an outer member configured to couple to the anchor body and aninner member configured to couple to the insertion member.
 13. Theanchoring system of claim 1 wherein the delivery device is configured tomove the insertion member relative to the anchor body along thelongitudinal axis by rotating the insertion member relative to theanchor body.
 14. The anchoring system of claim 1, further comprising aflexible member sized to be passed into the transverse hole in theanchor body and to be fixed relative to the anchor body when theinsertion member is moved within the cavity such that the insertionmember covers the transverse hole from a point proximal of the proximaledge to a point distal of the distal edge.
 15. The anchoring system ofclaim 1, further comprising a suture threader comprising: a clipconfigured to releasably clip to the delivery device, and a strand ofsuture that is passed through at least a portion of the transverse holeand couples to the clip.
 16. An anchoring system comprising: an anchorwith a longitudinal axis extending along a length of the anchor, theanchor comprising: an anchor body comprising: a proximal end positionedalong the longitudinal axis, a distal end positioned along thelongitudinal axis and opposite from the proximal end, a cavitypositioned along the longitudinal axis between the proximal end and thedistal end, an opening to the cavity at the proximal end of the anchorbody, and a transverse hole into the cavity, wherein the transverse holeincludes a proximal edge and a distal edge, wherein there are ridges onan interior portion of the cavity at substantially the same longitudinallocation as the transverse hole, and wherein the cavity has a workingdiameter that extends distal of the distal edge of the transverse holeand proximal of the proximal edge of the transverse hole, and aninsertion member with a minimum diameter along a length of the insertionmember sized to substantially fill the working diameter of the cavityfrom a point proximal of the proximal edge of the transverse hole to apoint distal of the distal edge of the transverse hole; and a deliverydevice configured to couple with the anchor and move the insertionmember relative to the anchor body along the longitudinal axis.
 17. Theanchoring system of claim 16 wherein the transverse hole into the cavitygoes through each side of the anchor body and goes through the cavitybetween each side of the anchor body.
 18. The anchoring system of claim16 wherein the ridges are formed by threads within the cavity.
 19. Theanchoring system of claim 16 wherein the anchor body includes one ormore barbs on an exterior of the anchor body positioned to resistproximal movement of the anchor from a bone.
 20. The anchoring system ofclaim 16 wherein the anchor body includes one or more protrusions on anexterior of the anchor body located distal of the transverse hole intothe cavity.
 21. The anchoring system of claim 16 wherein the anchor bodyincludes a pointed distal portion configured for insertion into a bonewithout prior creation of a hole in the bone.
 22. The anchoring systemof claim 16 wherein the insertion member is headless such that theinsertion member is configured to be driven by placing an inner memberof the delivery device into a proximal end of the insertion memberwithout engaging any head of the insertion member.
 23. The anchoringsystem of claim 16 wherein the insertion member includes an end having asubstantially flat profile.
 24. The anchoring system of claim 23 whereinthe end of the insertion member having a substantially flat profile is asubstantially solid substantially flat end.
 25. The anchoring system ofclaim 23 wherein the end having a substantially flat profile is a distalend of the insertion member.
 26. The anchoring system of claim 23wherein the insertion member with an end having a substantially flatprofile is sized and configured to be moved distally within the cavityof the anchor body such that the insertion member covers the transversehole from a point proximal of the proximal edge to a point distal of thedistal edge, wherein after such covering movement the end having thesubstantially flat profile may be located at a point distal of thedistal edge.
 27. The anchoring system of claim 16 wherein the deliverydevice includes an outer member configured to couple to the anchor bodyand an inner member configured to couple to the insertion member. 28.The anchoring system of claim 16 wherein the delivery device isconfigured to move the insertion member relative to the anchor bodyalong the longitudinal axis by rotating the insertion member relative tothe anchor body.
 29. The anchoring system of claim 16, furthercomprising a flexible member sized to be passed into the transverse holein the anchor body and to be fixed relative to the anchor body when theworking diameter of the insertion member is within the cavity from apoint proximal of the proximal edge to a point distal of the distaledge.
 30. The anchoring system of claim 16, further comprising a suturethreader comprising: a clip configured to releasably clip to thedelivery device, and a strand of suture that is passed through at leasta portion of the transverse hole and couples to the clip.
 31. Ananchoring system comprising: an anchor with a longitudinal axisextending along a length of the anchor, the anchor comprising: an anchorbody comprising: a proximal end positioned along the longitudinal axis,a distal end positioned along the longitudinal axis and opposite fromthe proximal end, a cavity positioned along the longitudinal axisbetween the proximal end and the distal end, an opening to the cavity atthe proximal end of the anchor body, and a transverse hole into thecavity, wherein the transverse hole includes a proximal edge and adistal edge, wherein there are ridges on an interior portion of thecavity at substantially the same longitudinal location as the transversehole, and wherein the cavity extends distal of the distal edge of thetransverse hole and proximal of the proximal edge of the transversehole, and an insertion member sized and configured to be moved withinthe cavity to cover the transverse hole, wherein the insertion memberincludes a typical outer body diameter, wherein the typical outer bodydiameter is smaller than a diameter of any threads on the insertionmember and smaller than a diameter of any head of the insertion memberand larger than a dimension of the transverse hole into the cavity thatis substantially perpendicular to the longitudinal axis of the anchor,and wherein the anchor is sized and configured such that the typicalbody diameter of the insertion member fits within the cavity from apoint proximal of the proximal edge of the transverse hole to a pointdistal of the distal edge of the transverse hole, and a delivery deviceconfigured to couple with the anchor and move the insertion memberrelative to the anchor body along the longitudinal axis.
 32. Theanchoring system of claim 31 wherein the transverse hole into the cavitygoes through each side of the anchor body and goes through the cavitybetween each side of the anchor body.
 33. The anchoring system of claim31 wherein the ridges are formed by threads within the cavity.
 34. Theanchoring system of claim 31 wherein a portion of the cavity proximal ofthe transverse hole includes threads.
 35. The anchoring system of claim31 wherein the anchor body includes one or more barbs on an exterior ofthe anchor body positioned to resist proximal movement of the anchorfrom a bone.
 36. The anchoring system of claim 31 wherein the anchorbody includes one or more protrusions on an exterior of the anchor bodylocated distal of the transverse hole into the cavity.
 37. The anchoringsystem of claim 31 wherein the anchor body includes a pointed distalportion configured for insertion into a bone without prior creation of ahole in the bone.
 38. The anchoring system of claim 31 wherein theinsertion member is headless such that the insertion member isconfigured to be driven by placing an inner member of the deliverydevice into a proximal end of the insertion member without engaging anyhead of the insertion member.
 39. The anchoring system of claim 31wherein the insertion member includes an end having a substantially flatprofile.
 40. The anchoring system of claim 39 wherein the end of theinsertion member having a substantially flat profile is a substantiallysolid substantially flat end.
 41. The anchoring system of claim 39wherein the end having a substantially flat profile is a distal end ofthe insertion member.
 42. The anchoring system of claim 39 wherein thediameter of the end of the insertion member having a substantially flatprofile is substantially the same diameter as the typical outer bodydiameter.
 43. The anchoring system of claim 39 wherein the insertionmember with an end having a substantially flat profile is sized andconfigured to be moved distally within the cavity of the anchor bodysuch that the insertion member covers the transverse hole from a pointproximal of the proximal edge to a point distal of the distal edge,wherein after such covering movement the end having the substantiallyflat profile may be located at the point distal of the distal edge. 44.The anchoring system of claim 31 wherein the delivery device includes anouter member configured to couple to the anchor body and an inner memberconfigured to couple to the insertion member.
 45. The anchoring systemof claim 31 wherein the delivery device is configured to move theinsertion member relative to the anchor body along the longitudinal axisby rotating the insertion member relative to the anchor body.
 46. Theanchoring system of claim 31, further comprising a flexible member sizedto be passed into the transverse hole in the anchor body and to be fixedrelative to the anchor body when the insertion member is within thecavity such that the insertion member covers the transverse hole from apoint proximal of the proximal edge to a point distal of the distaledge.
 47. The anchoring system of claim 31, further comprising a suturethreader comprising: a clip configured to releasably clip to thedelivery device, and a strand of suture that is passed through at leasta portion of the transverse hole and couples to the clip.